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Patricia Carrera

How to spot Medicare fraud

Review your Medicare Summary Notices for errors and report anything suspicious to Medicare.

  • Compare the dates and services on your calendar with the statements you get from Medicare to make sure you got each service listed and that all the details are correct.
    • These include the “Medicare Summary Notice” (MSN) if you have Original Medicare , or similar statements from your plan if you’re in a Medicare Advantage Plan. They list the services you got or prescriptions you filled.
    • Check your claims early—the sooner you see and report errors, the sooner you can help stop fraud. Log into (or create) your secure Medicare account to view your Original Medicare claims as soon as they’re processed, or call us at 1-800-MEDICARE (1-800-633-4227).
  • Check the receipts and statements you get from providers for mistakes.

If you think a charge is incorrect and you know the provider, you may want to call their office to ask about it. The person you speak to may help you better understand the services or supplies you got, or they may realize a billing error was made.

If you’ve contacted the provider and you suspect that Medicare is being charged for health care you didn’t get, or you don’t know the provider on the claim, find out how to report fraud.

Concerns over eldercare beginning to show up in workplace

Without adequate caregiving support for employees, companies incur millions of dollars of hidden costs. More than half of survey respondents say their supervisors were not as supportive as they needed them to be about their outside-of-work caregiving responsibilities.

An aging population and a trend toward remote work may increase demand for eldercare as a voluntary benefit.

Two-thirds of respondents in the Homethrive 2021 Employee Caregiving Survey said expanding access to home-based care for the elderly is important. This expansion is more popular than free pre-kindergarten and childcare assistance to middle-class families.

Moreover, this concern may affect job performance:

  • 43% of respondents said they are distracted, worried or focused on caregiving five or more hours per week.
  • One in five are distracted at work more than nine hours per week.
  • Nearly 40% said their supervisor either is not aware of their caregiving responsibilities outside of work or aren’t sure if their supervisor is aware.
  • More than half indicated their supervisors were not as supportive as they needed them to be about their outside-of-work caregiving responsibilities.
  • One-third of respondents said their supervisor had noticed a change because it was affecting their performance or because they were noticeably under stress because of their caregiving responsibilities.

For complete article, CLICK HERE.

What is Medicare and what does it cover?

Medicare pays for health care for:

  • People age 65 years and older
  • People under age 65 with receiving Social Security Disability benefits
  • People of all ages diagnosed with Amyotrophic Lateral Sclerosis (ALS or Lou Gehrig’s disease) or end-stage renal disease (permanent kidney failure that requires dialysis or a kidney transplant).

Medicare covers medically necessary care for acute care, such as doctor visits, drugs, and hospital stays.

Except for the specific circumstances described below, Medicare does not pay for most long-term care services or personal care— such as help with bathing or for supervision (often referred to as custodial care).

When Does Medicare Pay for Long-term Care Services?

Following Hospitalization

Medicare will help pay for a short stay in a skilled nursing facility if you meet all of the following conditions:

  • You have had a hospital admission with an inpatient stay of at least three days
  • You are admitted to a Medicare-certified nursing facility within 30 daysof that inpatient hospital stay
  • You need skilled care, such as skilled nursing services, physical therapy, or other types of therapy

If you meet all these conditions, Original Medicare will pay a portion of the costs for up to 100 days for each benefit period as follows:

  • For the first 20 days, Medicare pays 100 percent of the cost.
  • For days 21 through 100, you pay a daily copayment, which was $164.50 as of November 2017), and Medicare pays any balance.
  • Medicare does not pay costs for days you stay in a skilled nursing facility after day 100.

(Medicare Advantage plans must cover the same services, but the cost sharing may vary.)

To treat medical conditions

Medicare pays for the following services when your doctor prescribes them as medically necessary to treat an illness or injury:

  • Part-time or intermittent skilled nursing care
  • Physical therapy, occupational therapy, and speech-language pathology provided by a Medicare-certified home health agency.
  • Medical social services to help cope with the social, psychological, cultural, and medical issues that result from an illness. This may include help accessing services and follow-up care, explaining how to use health care and other resources, and help understanding your disease
  • Medical supplies and durable medical equipment such as wheelchairs, hospital beds, oxygen, and walkers. For durable medical equipment, Medicare pays 80 percent of approved amount and you pay 20 percent.

There is no limit on how long you can receive any of these services as long as they remain medically necessary and a doctor reorders them every 60 days. There also is no requirement for your condition to improve, or for improvement to be expected.

To prevent further decline due to medical conditions

In some cases, Medicare also covers ongoing long-term care services to prevent further decline for people with medical conditions that may not improve. This can include conditions like stroke, Parkinson’s disease, ALS, Multiple Sclerosis, or Alzheimer’s disease.

Hospice care

Medicare covers hospice care if you have a terminal illness, are no longer seeking a cure, and you are not expected to live more than six months. With hospice care, Medicare covers drugs to control symptoms of the illness and pain relief, medical and support services from a Medicare-approved hospice provider, limited respite care, and other services that Medicare does not otherwise cover, such as grief counseling. You may receive hospice care in your home, in a nursing home, or in a hospice care facility. Medicare also pays for some short-term hospital stays and inpatient care for caregiver respite.

Resources for additional Medicare information or help:

Last modified on 02/18/2020
For more information – www.longtermcare.gov or www.acl.gov

5 opportunities Social Security’s new statements offer advisors, participants

Social Security statements already served as handy tools. But the changes that the Social Security Administration is rolling out will help advisors and clients even more.

Advisors who have never used their clients’ Social Security statements to provide a clearer picture of how much they will get when they retire have been missing an opportunity, according to advisors and financial planners interviewed by BenefitsPRO’s sister site, ThinkAdvisor.

That opportunity has grown even larger with the enhanced statement, which shows the effects of starting benefits each year between age 62 and 70. The SSA recently rolled out the new, shorter statements to a limited number of Americans.

Research has shown that people who see their statements tend to make better retirement choices, according to Jeffrey Levine, chief planning officer at Buckingham Wealth Partners.

He and the others we interviewed pointed to five key things advisors can do now with Social Security statements to help clients.

1. Take advantage of the enhanced statement’s standout feature.

The new version of the statement provides a “really easy graphical way of showing people, right on that first page, what their benefit will be by delaying” their retirement,” said Levine.

After all, rather than just ages 62, 67 and 70, the redesigned statement shows what the estimated monthly benefits would be for each of nine years if you start receiving benefits from ages 62-70 — in a personalized graphic with a series of horizontal bars. At 62, it is tempting to say “70 is so far away,” he said. But when you’re talking about 63, the client might say, “63’s not so bad and look, next year I get more if I wait,” he noted.

“That is the biggest change on the form and that’s what probably” will drive the most advisor conversations with clients once the enhanced version is made available to more Americans, he added.

Advisors can already illustrate this through software. But the new statement offers a “very quick and dirty way of going about this,” Levine told ThinkAdvisor.

Jody King, vice president and director of wealth planning at private wealth management firm Fiduciary Trust in Boston, said she had yet to see an enhanced statement. But, based on what she saw and heard about the redesigned statement, she too gave a thumbs-up to the expanded number of retirement ages included in it.

Robert Conzo, CEO, managing director and co-founder (with Eric Diton) of The Wealth Alliance, an RIA based in Melville, New York, agreed also.

“That one change, from a financial planning perspective, really makes” the client’s cash flow and “retirement picture going forward much, much more accurate,” Conzo said.

2. Discuss if the amount clients will receive when they retire will be enough to live on.

Even before the enhanced statement, “there’s plenty that advisors should be doing with respect to Social Security statements,” according to Levine.

The statement could already be used by advisors to help clients in “understanding the various benefits to which [they] may be entitled,” he said.

For example, he said, an advisor can ask a client: If he or she were to become disabled, would the amount that person stands to receive each month be enough for them to get by on, based on what the statement shows for specific retirement ages?

“The answer in most cases for advisors’ clients is going to be no,” he said, and “that leads to other discussions, such as: Do we need to look for disability coverage? How would we reduce your expenses if these things happen?”

3. Make sure clients are reviewing their statements for errors.

Going through the statement and looking at the earnings history for each client is something that advisors should be doing regularly, according to Levine. For clients who are still working, they should be checking to make sure that earnings are reported properly each year and, if not, helping the clients contact the SSA to rectify that, he said.

4. Check that clients have created online SSA accounts.

In addition to making sure that clients are seeing their statements, it is crucial for advisors to make sure clients have created an online account at the SSA’s website so they can access the statements digitally, Levine said.

Agreeing, King said, “it’s so important for so many reasons and people don’t do it.” Unfortunately, the “vast majority” of her clients do not set up online SSA accounts until her firm encourages them to do so, she said.

Also, because of all the data breaches in recent years, “probably most of our Social Security numbers are out there,” she said. Therefore, she explained: “It’s better to be proactive. Set up your account so somebody else can’t.”

5. Be sure clients understand that Medicare costs come out of their monthly Social Security payments.

“The most misunderstood aspect of Social Security is how Medicare is paid” among Conzo’s clients, he said. “Most people don’t realize that Medicare … gets paid out of your Social Security benefit,” he said.

One way to further enhance the statement, therefore, would be if it includes a noticeable, “very short blurb” explaining this, he said. “Even sophisticated people that are smart” still don’t understand this, he added.

By Jeff Berman | July 22, 2021 at 03:01 PM | The original version of this story was published on ThinkAdvisor

Ask Your Legislators to Put an End to the Observation-Status Loophole

Currently, Medicare beneficiaries who are not officially admitted to a hospital may be classified under “observation status,” which is treated as an outpatient procedure for billing purposes. Unfortunately, the common practice of placing a beneficiary on observation status can have significant financial consequences for Medicare beneficiaries since Medicare Part A and its related coverage rules only apply to actual inpatient care admissions. This may lead patients, many who are extremely sick and may need skilled nursing care, to spend many days in the hospital and be charged for services that Medicare would have otherwise paid had they been admitted. Furthermore, hospitals have up to one year to retroactively change admission status to observation, leading unsuspecting beneficiaries with thousands of dollars in bills for SNF care they believed would be covered by Medicare.

Click Here to View The Complete Article

World Elder Abuse Awareness Day

June 15th is World Elder Abuse Awareness Day (WEAAD). This day provides an opportunity for communities around the world to promote a better understanding of abuse and neglect of older people by raising awareness of the cultural, social, economic, and demographic processes affecting elder abuse and neglect.

This year’s WEAAD theme is “Building Strong Support for Elders.” Many different service providers across disciplines have a role in addressing elder abuse and empowering older adults. Civil legal aid providers and elder rights professionals are well-positioned to provide legal help to older adults who have experienced abuse or maltreatment, by providing individual representation to ensure protection, redress, and ongoing stability. NCLER’s Elder Justice Toolkit contains actionable resources for civil legal aid attorneys and advocates to respond to elder abuse, utilizing trauma-informed and culturally competent strategies.

A multidisciplinary and collaborative approach to addressing elder abuse often provides more effective outcomes for older adults who have experienced abuse. These resources provide additional guidance and support for a wide-range of professionals:

Visit The Elder Justice Toolkit

How do Medicare Advantage Plans work?

Medicare Advantage Plans, sometimes called “Part C” or “MA Plans,” are an “all in one” alternative to Original Medicare. They are offered by private companies approved by Medicare.  If you join a Medicare Advantage Plan, you still have Medicare.  These “bundled” plans include  Medicare Part A (Hospital Insurance) and Medicare Part B (Medical Insurance), and usually Medicare drug coverage (Part D).

Find Medicare Advantage Plans in your area.

Covered services in Medicare Advantage Plans

Most Medicare Advantage Plans offer coverage for things Original Medicare doesn’t cover, like some vision, hearing, dental, and fitness programs (like gym memberships or discounts). Plans can also choose to cover even more benefits. For example, some plans may offer coverage for services like transportation to doctor visits, over-the-counter drugs, and services that promote your health and wellness. Plans can also tailor their benefit packages to offer these benefits to certain chronically-ill enrollees. These packages will provide benefits customized to treat specific conditions. Check with the plan before you enroll to see what benefits it offers, if you might qualify, and if there are any limitations.  Learn more about what Medicare Advantage Plans cover.

Rules for Medicare Advantage Plans

Medicare pays a fixed amount for your care each month to the companies offering Medicare Advantage Plans. These companies must follow rules set by Medicare.

Each Medicare Advantage Plan can charge different out-of-pocket costs. They can also have different rules for how you get services, like:

  • Whether you need a referral to see a specialist
  • If you have to go to doctors, facilities, or suppliers that belong to the plan for non-emergency or non-urgent care

These rules can change each year.

Costs for Medicare Advantage Plans

What you pay in a Medicare Advantage Plan depends on several factors. In many cases, you’ll need to use doctors and other providers who are in the plan’s network and service area for the lowest costs. Some plans won’t cover services from providers outside the plan’s network and service area. 

Learn about these factors and how to get cost details.

Drug coverage in Medicare Advantage Plans

Most Medicare Advantage Plans include prescription drug coverage (Part D). You can join a separate Medicare Prescription Drug Plan with certain types of plans that:

  • Can’t offer drug coverage (like Medicare Medical Savings Account plans)
  • Choose not to offer drug coverage (like some Private Fee-for-Service plans)

You’ll be disenrolled from your Medicare Advantage Plan and returned to Original Medicare if both of these apply:

  • You’re in a Medicare Advantage HMO or PPO.
  • You join a separate Medicare Prescription Drug Plan.

How Medicare Supplement Insurance (Medigap) policies work with Medicare Advantage Plans

Medigap policies can’t work with Medicare Advantage Plans. Learn about your options related to Medigap policies and Medicare Advantage Plans.
Click here for statistics – Click Here
For More Medicare information go to – Medicare.gov

Center for Medicare & Medicaid – CMS Fraud Prevention Initiative

The federal government has made important strides in reducing fraud, waste and improper payments across the government. The Affordable Care Act provided additional resources and tools to enable the Centers for Medicare & Medicaid Services (CMS) to expand its efforts to prevent fraud, waste and improper payments. The same innovative tools are being used to further enhance collaboration with our State and law enforcement partners in detecting and preventing fraud.

Using tools provided under the ACA, CMS has used a multifaceted approach, ranging from provider screening to the use of predictive modeling technology similar to that used by credit card companies that has saved nearly $60 billion during 2013-15. This equates to an average savings of $12.40 for each dollar spent on these program integrity efforts.

Guard Your Card Campaign

The CMS “Guard Your Card” campaign tells people how they can protect themselves against fraud by:

  • Never giving out their Medicare or Social Security Number to anyone except those you know should have it.
  • Reporting any suspicious activities like being asked over the phone for their Medicare/Social Security number or banking information. Medicare will NEVER call you uninvited for this information.
  • By checking their billing statements and reporting suspicious charges. Using a calendar to track doctor’s appointments and services helps quickly spot possible fraud and billing mistakes. Check claims early by logging into mymedicare.gov.

Please report suspicious activities by calling 1-800-MEDICARE (1-800-633-4227).

Help Prevent Fraud – Click Here
The 4Rs on Fighting Fraud – Click Here

How working affect your Social Security benefits

You can get Social Security retirement or survivors benefits and work at the same time. But, if you’re younger than full retirement age, and earn more than certain amounts, your benefits will be reduced. The amount that your benefits are reduced, however, isn’t truly lost. Your benefit will increase at your full retirement age to account for benefits withheld due to earlier earnings.

Click here for more details.

Extra Help with Part D

What is Extra Help with Medicare prescription drug plan costs? Anyone who has Medicare can get Medicare prescription drug coverage. Some people with limited resources and income also may be able to get Extra Help with the costs — monthly premiums, annual deductibles, and prescription co-payments — related to a Medicare prescription drug plan.

Click here for more details.